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216 | 8 Ways to Finally Get Rid of Swelling After ACL Surgery - Part 1 · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:05
  SPEAKER_00: So today we are doing a two-part series with part one today, doing a deep dive into swelling.
• 1:13
  SPEAKER_00: The bane of our existence and what we loathe as PTs, coaches, especially as ACLers, it is just something that we have to deal with with this territory of just getting injured and with surgery.
• 1:29
  SPEAKER_00: And swelling just loves to be a pain in the butt.
• 1:34
  SPEAKER_00: So, with that said, the thing with swelling is that it can be a little bit more challenging compared to pain.
• 1:41
  SPEAKER_00: Now, these are both things that people feel after an injury or for surgery.
• 1:46
  SPEAKER_00: Pain is something that we can navigate around, especially if it's not sharp.
• 1:51
  SPEAKER_00: Sharpness is a little bit more challenging with the early post-op and post-injury because things are just really at a high sensitivity.
• 2:00
  SPEAKER_00: Um, and there may be something in there that's truly damaged, right?
• 2:04
  SPEAKER_00: But then as time goes on, whether it's after injury or surgery, that sharpness slowly starts to decrease, and then we start to just have kind of dull pain, aching, all the things, right?
• 2:16
  SPEAKER_00: And it could be from a number of reasons.
• 2:18
  SPEAKER_00: But with swelling, it's also something that is typically accompanied whenever there is an inflammatory response and whenever the body is noticing there's a threat, and especially when healing needs to take place because it's taking all of these white blood cells and all these things we need to get there to help repair, turn tissue over, and all the things, right?
• 2:40
  SPEAKER_00: But it's something that can just be a bit more challenging and it makes the knee feel tight like a balloon, especially if we're working into more flexion-based work.
• 2:50
  SPEAKER_00: Um, it can make it feel stiff, it can really impact the strength, especially with the quads, as we know, just kind of weakness feeling around the joint.
• 2:59
  SPEAKER_00: And there's just so many things that people will report.
• 3:02
  SPEAKER_00: And trust me, I've had my own fair share of knee swelling with my two ATL injuries, my reconstructions, and honestly, over the past 17 years since my first ATL injury.
• 3:14
  SPEAKER_00: So I've had experiences with this, and it's just something that just becomes a real big pain because sometimes it's not even actual pain itself that's limiting, it's just the tightness and fullness of the joint, feeling like it's just kind of like a very, very tight balloon, especially if you bend the knee into flexion positions.
• 3:34
  SPEAKER_00: Um, but we still notice it when we're standing, it just makes things feel stiff, and it's something that creates a massive barrier for ACLers and clinicians and coaches working with ACLers.
• 3:44
  SPEAKER_00: It's shown to persist for an average of three months post-ACL injury and up to 12 months post-ACL reconstruction.
• 3:52
  SPEAKER_00: Frobel in 2008 had reported that.
• 3:56
  SPEAKER_00: And you know, this can really span across a lot of different timelines based on the person and a number of other factors, right?
• 4:04
  SPEAKER_00: And piggybacking off of this, there's a study by Tory in 2000 where they injected the joint with 20 to 60 milliliters of fluid, and it reduced quad strength on isokinetic testing by 30 to 40 percent.
• 4:21
  SPEAKER_00: That is just some insight and how much some swelling can really influence things.
• 4:26
  SPEAKER_00: And we see this firsthand with ACLers when they're dealing with swelling, and as we know with AMI, it's a big thing that we deal with.
• 4:33
  SPEAKER_00: Arthrogenic muscle inhibition and swelling is a very big connection with that and how it influences the activation of the quads and some of the more complex, you know, neurological system as well in terms of this AMI.
• 4:49
  SPEAKER_00: And so it's interesting to see that even just putting fluid into the joint influences quad strength.
• 4:55
  SPEAKER_00: And this study and just injecting the joint with fluid, there are other studies on this that thing is really cool.
• 5:01
  SPEAKER_00: Um, not in the best way for ACL rehab, but it gives us a lot of information regarding how much swelling influences things.
• 5:08
  SPEAKER_00: So I will be diving into a future episode talking about this particular subject of studies injecting the joint and the byproduct of that.
• 5:17
  SPEAKER_00: But as we know, the quads are impacted, right?
• 5:20
  SPEAKER_00: And some people are just naturally more prone to swelling, effusion compared to others.
• 5:27
  SPEAKER_00: And there are so many factors that influence this, y'all.
• 5:30
  SPEAKER_00: We can't pick just one thing.
• 5:32
  SPEAKER_00: We might have an idea of one thing based on just like tracking people's history and maybe more obvious things, but there's a lot of things at play.
• 5:40
  SPEAKER_00: Think about the history of your knee coming into the ACL injury and the surgery, um, your age, your genetics, the injury itself, and what all was injured, the time between the injury and if you have surgery, the surgery itself and all that was done, the graph type, weight bearing status immediately after.
• 5:58
  SPEAKER_00: Um, was the meniscus impacted?
• 6:01
  SPEAKER_00: Was it repaired?
• 6:02
  SPEAKER_00: Was it a menisectomy?
• 6:04
  SPEAKER_00: Bone bruising makes a huge impact on this, or any type of fracture, um, any other ligament damage.
• 6:11
  SPEAKER_00: Just think about all those things that could play a role in this, and then also the surgery afterwards.
• 6:16
  SPEAKER_00: You know, an isolated ACL versus an isolated ACL plus MCL plus meniscus.
• 6:21
  SPEAKER_00: Knee's probably gonna feel a little different based on different structures being impacted versus just one single structure.
• 6:28
  SPEAKER_00: And then all those different structures also have just different responses to the way body responds to it from you know, pain, swelling, and just a healing standpoint as well, because of blood flow.
• 6:40
  SPEAKER_00: So all those things will be influenced based on the different structures and tissues within the knee.
• 6:45
  SPEAKER_00: And then other things to think about, right, is going to be just your due diligence of elevating, compressing, doing your rehab stuff, maybe doing too much or too little, the crutch use afterwards.
• 6:57
  SPEAKER_00: A lot of times people just ditch their crutches too fast.
• 7:00
  SPEAKER_00: And so those are things that we see a lot of the times.
• 7:03
  SPEAKER_00: Life itself, whether you are working, the type of work you do, are you a remote worker?
• 7:08
  SPEAKER_00: Do you use a computer?
• 7:09
  SPEAKER_00: Or are you someone on your feet, a teacher, a nurse, you know, a doc who's in the ER doing 12-hour, 24-hour shifts, might be a little different, right?
• 7:19
  SPEAKER_00: Whether you're traveling or a wedding's coming up, like there's all these things that play into life that we don't necessarily look at, but it's crazy how much this influences people and their knee and how it's feeling.
• 7:32
  SPEAKER_00: And it's just something about being on your feet, right?
• 7:34
  SPEAKER_00: It's the gravity of it, it's just the compression of joint.
• 7:38
  SPEAKER_00: There's a lot of things at play.
• 7:40
  SPEAKER_00: And I haven't even named all the factors in this, but those are ones that do happen along with other things going on.
• 7:47
  SPEAKER_00: So just keep that in mind that we can't always just narrow it in on one thing because there's usually a lot of different things at play because of the complexity of the knee, the complexity of the human body, the complexity of our lives, right?
• 8:01
  SPEAKER_00: But our goal immediately post ACO injury and post-surgery is to get that swelling out.
• 8:07
  SPEAKER_00: Now, everyone out there can say, Oh, we need swelling and inflammation for the healing, don't mess with that.
• 8:13
  SPEAKER_00: Yeah, that's fine.
• 8:15
  SPEAKER_00: But the that's gonna take its place no matter what.
• 8:17
  SPEAKER_00: And let's get the swelling out because we know at this point, current day, 2025, swelling equals not great for the knee and not great for the quads.
• 8:27
  SPEAKER_00: Guess what?
• 8:27
  SPEAKER_00: One of our goals is post-op and post-injury.
• 8:30
  SPEAKER_00: Get those quads going, get your extension back.
• 8:33
  SPEAKER_00: And swelling just really rears its head against that because one thing that's important with this is to consider just the joint mechanics when swelling is in there.
• 8:43
  SPEAKER_00: Whenever the knee is fully straight, it's in this most compressed position in terms of just uh not having as much room within that joint.
• 8:51
  SPEAKER_00: So then it adds pressure to that joint when you're in full extension.
• 8:55
  SPEAKER_00: And it's open pack position or just like a bend in that knee, is where that knee has a little bit more room to breathe because those joints aren't pushed together.
• 9:04
  SPEAKER_00: So then, therefore, that's why the knee always likes to be in a slightly bent position after an injury or after a surgery.
• 9:11
  SPEAKER_00: Um, even though it's quote unquote locked in a brace, I promise you that knee is not totally straight.
• 9:16
  SPEAKER_00: It is still slightly bent by some degrees after surgery and after injury, in the most part.
• 9:22
  SPEAKER_00: Even if your brace is zero degrees, if your brace is negative five degrees, it's probably still hanging out in there because those straps aren't perfect.
• 9:30
  SPEAKER_00: And so, with that said, that influences the pressure in the joint and it also influences the way that the joint is feeling in terms of that swelling.
• 9:42
  SPEAKER_00: And so, as I mentioned, the goal after post-ACL injury and surgery is to get that swelling out.
• 9:50
  SPEAKER_00: It's part of our goal to achieve the quiet knee.
• 9:54
  SPEAKER_00: We want our symptom profile calmed down.
• 9:57
  SPEAKER_00: That's our pain, and we want swelling to also go down, right?
• 10:01
  SPEAKER_00: And as research has shown with AMI, as I'd mentioned, the arthogenic muscle inhibition, it's basically a neurological disconnect of your quads wanting to kick on.
• 10:12
  SPEAKER_00: There are other things at play, but the way you can kind of think about this is you got a Christmas tree and you have lights on it and it's fully lit up.
• 10:19
  SPEAKER_00: And what ends up happening is that when you go to actually plug it in or light it up, it's only halfway lit up, right?
• 10:26
  SPEAKER_00: So the other 50% of the bulbs aren't turning on.
• 10:30
  SPEAKER_00: So basically, it is not firing at the rate it normally should with our motor unit recruitment, and there's a lot of things going on in terms of the neurological system locally and centrally in our spinal cord and brain.
• 10:44
  SPEAKER_00: It's crazy, y'all.
• 10:45
  SPEAKER_00: There's a lot of things that change after an ACL injury, and it's not just a knee joint injury or a muscle injury.
• 10:51
  SPEAKER_00: It is something that is way more complex than any of us can ever explain.
• 10:56
  SPEAKER_00: But with that said, swelling and effusion has shown to play a massive role in this AMI, which is why our goal is operation get the freaking swelling out.
• 11:07
  SPEAKER_00: And so we focus hard on this swelling management post op and throughout the process, which is why today I want to share with you eight ways to improve swelling after ACL injury and surgery.
• 11:20
  SPEAKER_00: And the reason I'm bringing this up is because we need practical ways to do this.
• 11:25
  SPEAKER_00: And so my goal today is to share this with you guys.
• 11:29
  SPEAKER_00: And I've shared some of these ways before, but I want to go into a little bit of a deeper dive.
• 11:33
  SPEAKER_00: So then that way you have strategies to do this, ways to assess it, and be able to put it in play for yourself because it's something that we all deal with, and it's ways that we help our athletes manage the swelling and be able to try and get rid of it because we want to try and get them back to the thing, and this thing ends up being a big, big barrier for a lot of folks.
• 11:57
  SPEAKER_00: And so the first way is to assess it, and that is to use a stroke or a sweep test.
• 12:06
  SPEAKER_00: Um, uh, you know, I know the literature refers to it as a stroke test.
• 12:10
  SPEAKER_00: A lot of times people refer to it as a sweep test to gauge it daily or semi-regularly.
• 12:16
  SPEAKER_00: And it's a five-point scale that you can utilize yourself.
• 12:19
  SPEAKER_00: You can look it up yourself.
• 12:21
  SPEAKER_00: It's pretty simple to assess.
• 12:22
  SPEAKER_00: You don't need some sort of massive degree for this, like you can do it.
• 12:26
  SPEAKER_00: And we teach a lot of our athletes how to do it.
• 12:29
  SPEAKER_00: And it usually has a lot more value once you're out of the early post-op phases because it's going to be so obvious you have swelling for most people.
• 12:38
  SPEAKER_00: And then as you start to just kind of increase like your training, maybe you start running and do dynamic stuff, like that's when sometimes it can rear its head and it's not as noticeable.
• 12:51
  SPEAKER_00: And so that's when this can have a lot more value, but it's also good to just assess as you go to see is it going down?
• 12:58
  SPEAKER_00: And it gives you a little bit more of an objective scale to it.
• 13:02
  SPEAKER_00: So there's five different points that you could be on this from no swelling all the way to swelling, is there no matter how I stroke the inside of the knee and then the outside of the knee, it's not moving at all because it's just full of fluid, right?
• 13:18
  SPEAKER_00: And there's the whole range in between.
• 13:20
  SPEAKER_00: And you can also use like a circumference measurement around the center of the knee joint for swelling to monitor it.
• 13:27
  SPEAKER_00: But I prefer the stroke test myself.
• 13:30
  SPEAKER_00: It's something that we teach our athletes and is something that helps us to monitor this.
• 13:35
  SPEAKER_00: And a lot of times what I see is with this stroke test is that you know, sometimes athletes are like, yeah, I don't have any swelling.
• 13:40
  SPEAKER_00: And then when we go to see this, you can actually see just a small little bit of fluid within that joint that moves when they do this stroke test.
• 13:48
  SPEAKER_00: So it might be trace or it might be one plus, for example, but it's not absent.
• 13:53
  SPEAKER_00: And so that influences potentially extension, the way the knee feels from a stiffness standpoint, the quads just kind of feeling like they're really doing their thing to just all the other activities and impact things that they might be doing, right?
• 14:09
  SPEAKER_00: So assessment is helpful to make sure we can just kind of keep tabs on this.
• 14:13
  SPEAKER_00: And as you guys know, we're big on testing and connecting numbers to things.
• 14:16
  SPEAKER_00: So using the sweep test is a high value add to your ACL rehab.
• 14:23
  SPEAKER_00: Number two is going to be your load management.
• 14:26
  SPEAKER_00: This is probably the biggest player that gets overlooked, but it's the thing that influences swelling and joint effusion more than anything.
• 14:36
  SPEAKER_00: And what load management essentially means is think about all the stress that you're cumulatively putting on the knee within a day, within multiple days, a week, multiple weeks, a month.
• 14:49
  SPEAKER_00: We're basically looking at what does that trend look like over time and are there any spikes in that?
• 14:55
  SPEAKER_00: And so we want to manage the volume and the intensity of those things to make sure that it is not too big of spikes.
• 15:01
  SPEAKER_00: And a lot of times what we see is that people just might be doing too much too soon.
• 15:06
  SPEAKER_00: And the challenge is that a lot of times people are super active prior to the ACL injury and surgery, so then therefore their threshold of high activity might be super high.
• 15:15
  SPEAKER_00: Um, and so then, therefore, when they think they're just like walking around the block or you know, being able to, you know, walk to school and back, for example, that that's so low compared to what they could do that that shouldn't influence things.
• 15:30
  SPEAKER_00: But it's all relative to where you're at in the most recent place you've been at.
• 15:35
  SPEAKER_00: And so with load management, it's just basically you might be doing too much too soon.
• 15:41
  SPEAKER_00: And this is also after a time where you might not have been doing too much, right?
• 15:44
  SPEAKER_00: Um, a lot of this can come back to a lot of injuries, to be honest.
• 15:48
  SPEAKER_00: It's just been underloaded, or we just haven't been able to keep a high capacity for it.
• 15:53
  SPEAKER_00: And so then we make jumps back to our regular lifestyle, and people just end up blowing the knee joint up, or it ends up being probably not a good thing to say on podcasts.
• 16:03
  SPEAKER_00: They just end up making the joint pretty grumpy, and it's just challenging because what happens is there's pain and swelling, and it might regress a little bit from range of motion and just muscle standpoint.
• 16:14
  SPEAKER_00: And so, with load management, you need to adjust your training and your volume to a level that your knee doesn't get swollen, right?
• 16:23
  SPEAKER_00: And so a simple example of this is running three miles creates swelling, but it's fine at one to two miles, right?
• 16:31
  SPEAKER_00: And it stays at this a little while longer, right?
• 16:35
  SPEAKER_00: Add smaller increments as you progress.
• 16:37
  SPEAKER_00: Maybe instead of a big mile jump, maybe you do a quarter mile or a half mile jump, right?
• 16:42
  SPEAKER_00: So these are ways for us to be able to monitor the volume of things and see how the knee responds to it.
• 16:48
  SPEAKER_00: It's a dose response.
• 16:49
  SPEAKER_00: And then use what we use is the 24-hour feedback loop to see if you what you did the day before is making it better, worse, or the same.
• 16:58
  SPEAKER_00: If it's worse, do less.
• 16:59
  SPEAKER_00: If it's the same or better, cool, keep moving forward.
• 17:03
  SPEAKER_00: If it's much better, then you can progress a little bit more, but don't make those big jumps, right?
• 17:08
  SPEAKER_00: So that's gonna be really key.
• 17:10
  SPEAKER_00: Now, within load management, step count is so huge.
• 17:14
  SPEAKER_00: And it's something that we talk to every single one of our athletes, especially post op and post injury, but especially as they might be getting back to something they need to do with a certain step count.
• 17:24
  SPEAKER_00: For example, the teacher I reference, or the nurse, or maybe it is someone who has to commute to work, or the high school athlete who is walking to school and walking around school.
• 17:36
  SPEAKER_00: Same thing with a college athlete.
• 17:38
  SPEAKER_00: So all these things are super important and it's highly underrated.
• 19:49
  SPEAKER_00: And so this is something that is gonna be really important.
• 19:51
  SPEAKER_00: This is load management in a nutshell.
• 19:54
  SPEAKER_00: Guess what?
• 19:54
  SPEAKER_00: We have smart devices now where your phone can track it, you have a watch that probably tracks it, any smartwatch does it, and they're super cheap things that you can get out there to be able to manage this and track it from a data standpoint, but put numbers to it.
• 20:09
  SPEAKER_00: And one of my athletes, she's a high school athlete, and she was wanting to be able to walk back to school with her friends.
• 20:16
  SPEAKER_00: And the thing is, is that she was having a little bit of a slower time with recovering post-ACL injury with just the knee being a little bit more grumpy, and so we had to just kind of check out and see like what was she walking before walking to school, and then also how much steps did she take at school?
• 20:35
  SPEAKER_00: And so we just try to look at the averages of those, and then we were able to compare, okay, where you are now versus where you were, and then we have a number to go off of, right?
• 20:45
  SPEAKER_00: And so maybe we slowly titrate that and see if we can increase the step count as long as the knee doesn't respond in a negative way.
• 20:52
  SPEAKER_00: So step count is huge, also huge if you're going on a big trip, and a lot of times people walk around, they might go and do things, and so the step count is elevated.
• 21:03
  SPEAKER_00: So then, therefore, it's just something to reference because a lot of times there's a relationship between when step count skyrockets and increases, and especially if it's back to back to back days, like if it's one day you might be okay to recover if you have a down day after, just like high low days.
• 21:22
  SPEAKER_00: But if you have back to back to back days, like you know, one day, two day, even or three day, just like with traveling, or maybe you just aren't paying attention and you just ramp things up too fast, then the knee can respond in a negative way, aka swelling and pain.
• 21:39
  SPEAKER_00: So step count management is gonna be key here, just like you would progress any type of other thing.
• 21:44
  SPEAKER_00: Running tends to be the best example here because people understand you're not gonna go just from you know a half a mile to a five mile jump, right?
• 21:52
  SPEAKER_00: But in step count territory, you go from a very low step count to something super high typically because of normal day stuff.
• 22:00
  SPEAKER_00: So just one thing to consider within load management.
• 22:03
  SPEAKER_00: Uh, another point within this is reduce how much you're standing in the day in the first two to four weeks, especially.
• 22:10
  SPEAKER_00: Um, you know, a lot of people want to get up, they want to move around.
• 22:13
  SPEAKER_00: And I used to be like, yeah, let's get you moving, let's get things going.
• 22:17
  SPEAKER_00: And there are time and place for that.
• 22:19
  SPEAKER_00: Don't get me wrong for conditioning effects and working out other places outside of just the knee itself and that area.
• 22:26
  SPEAKER_00: But with that said, your knee is going through a lot, and you need to understand that, like when you're standing, gravity is not your friend.
• 22:34
  SPEAKER_00: And so then, therefore, that influences how much it wants to send fluid down because gravity only works one specific way, and so that's why I truly believe we need to make sure we are very intentional about how much we're standing in the first, especially acute period of ACL rehab after surgery, after injury, because that won't influence how much that swelling in the fluid will stick around.
• 23:00
  SPEAKER_00: Anytime I ask people who have a remote job or they have time off after surgery, and those people just chill and you know they stand when they need to stand, get to A to B, do their exercises, maybe even do some off-feet conditioning.
• 23:14
  SPEAKER_00: But outside of that, if they are just chilling, like their knee is responding typically a lot better than the person who is up and about and moving around and not able to just kind of sit still in those first few weeks, especially.
• 23:26
  SPEAKER_00: So it makes a huge difference in your standing volume.
• 23:29
  SPEAKER_00: And so that's something to also monitor that gets overlooked.
• 23:33
  SPEAKER_00: Last point with load management that I want to make is don't get off your crutches, gradually wean off of them.
• 23:42
  SPEAKER_00: Everyone's familiar with our philosophy of don't dish your crutches too early.
• 23:47
  SPEAKER_00: Um, you know, the brace is what it is.
• 23:49
  SPEAKER_00: If you can get off that, that's awesome.
• 23:51
  SPEAKER_00: Not a big proponent of braces in general and ACL rehab.
• 23:54
  SPEAKER_00: But with that said, don't get off your crutches too fast.
• 23:58
  SPEAKER_00: Use your crutches longer than you think.
• 24:00
  SPEAKER_00: And most of my athletes love to give me a little bit of.
• 24:04
  SPEAKER_00: Role, especially my high schoolers, but you know, through this process, I've learned so much that being able to offload this leg is so important and manage all the input and stress that goes into it.
• 24:15
  SPEAKER_00: And the reason they give you crutches is to get from point A to B, but then also to offload this joint so it doesn't get stressed immediately.
• 24:23
  SPEAKER_00: It has been traumatized with lack of a better word because of an injury and a surgery.
• 24:29
  SPEAKER_00: And so then, therefore, we need to manage the amount of stress we input into the knee.
• 24:34
  SPEAKER_00: The goal of crutches is to really help that and let that knee joint heal and give it a very like comfortable state for it to do that.
• 24:42
  SPEAKER_00: Progress off the crutches gradually, even though you're cruising and doing well, go from two crutches to one crutch longer than you think, and then to no crutch versus like a cold turkey.
• 24:54
  SPEAKER_00: And I get it.
• 24:55
  SPEAKER_00: You're sick of having them with you, you're sick of people looking at you, like, why is that person on crutches?
• 24:59
  SPEAKER_00: You get stared at a little bit if you're in public.
• 25:02
  SPEAKER_00: Um, and you're in the house, right?
• 25:04
  SPEAKER_00: You're in your comfort zone.
• 25:05
  SPEAKER_00: You're like, how hard is it to get from A to B?
• 25:07
  SPEAKER_00: And I can kind of hobble over there, right?
• 25:09
  SPEAKER_00: And I get that.
• 25:10
  SPEAKER_00: I did it myself, so I'm not here to, you know, uh point any fingers.
• 25:15
  SPEAKER_00: But the thing that I have learned is that with being able to gradually come off this, people's swelling improves, their pain improves, and their gait pattern gets a lot better over a shorter period of time, even though they think getting off the crutches within a few days or a week or so will do them better in the long run.
• 25:35
  SPEAKER_00: I oppose that.
• 25:37
  SPEAKER_00: And the other thing is just because a protocol says that the protocol doesn't know your situation, your knee, your lifestyle factors, what was done specifically in that knee.
• 25:48
  SPEAKER_00: Um, and so then therefore, with that said, the protocol timing, you know, use that super loosely.
• 25:55
  SPEAKER_00: Um, yeah, should you be off crutches after you know probably like two months or three months?
• 25:59
  SPEAKER_00: Yes, of course.
• 26:00
  SPEAKER_00: But with that said, like the variance of crutch use can really depend on the person and just a lot of factors within their life and the surgery itself.
• 26:09
  SPEAKER_00: So um don't be ashamed if you're somebody who is four weeks, six weeks, eight weeks, honestly, even 10, 12 weeks out, and they're still using a crutch.
• 26:17
  SPEAKER_00: And we've had situations where this has had to be in play and they're unique situations.
• 26:23
  SPEAKER_00: But with that said, if you have a meniscus repair, guess what?
• 26:26
  SPEAKER_00: You're probably non-weight bearing for a minute, and you're gonna have to gradually come off that crutch.
• 26:30
  SPEAKER_00: So if you hit the two-week mark, six-week, four-week mark, six-week mark, and you're just like, oh, cool, it's been long enough.
• 26:38
  SPEAKER_00: I just need to come off.
• 26:39
  SPEAKER_00: I'm non-weight bearing now, weight bearing is tolerated.
• 26:41
  SPEAKER_00: Still use this progression because guess what?
• 26:44
  SPEAKER_00: You've unloaded the knee for a longer period of time, and as soon as you start to put weight through that thing, that thing is gonna experience some shock.
• 26:52
  SPEAKER_00: So, therefore, take your time with getting off crutches no matter where you are in this process, and do it longer than you think.
• 27:00
  SPEAKER_00: So the next one is elevation.
• 27:03
  SPEAKER_00: So, a lot of you may remember this from the RICE acronym: REST, ICE Compression, Elevation After an Acute Injury.
• 27:12
  SPEAKER_00: Not a big fan of that one, and I know that there has been some pushback on the rest piece, even some of the other ones like ice, for example.
• 27:20
  SPEAKER_00: But in reality, there are new ones that can be more helpful.
• 27:24
  SPEAKER_00: Um, there is peace and love, which I think is way too long.
• 27:27
  SPEAKER_00: But with that said, police is a super easy one that I like.
• 27:32
  SPEAKER_00: So it's protection, optimal loading.
• 27:34
  SPEAKER_00: That's the OL of police, and then there's ice compression elevation.
• 27:39
  SPEAKER_00: So we want to make sure we find the sweet spot with loading.
• 27:42
  SPEAKER_00: We don't want to just completely rest for two weeks, four weeks, etc.
• 27:46
  SPEAKER_00: Like we want to find the sweet spot with loading, either the affected area, surrounding areas, or maybe it's the unaffected areas, right?
• 27:54
  SPEAKER_00: Like being able to load the other leg or being able to load the upper body.
• 27:58
  SPEAKER_00: Um, but we want to just find the sweet spot with that because it is helpful instead of just completely unloading, unless it might be something like a bone injury, for example.
• 28:08
  SPEAKER_00: So someone has a fracture, but then there's still other things to work around to continue loading and to continue to keep fitness up and strength up and whatnot.
• 28:16
  SPEAKER_00: So elevation is a part of the police and it's something that is important with swelling.
• 28:23
  SPEAKER_00: And here we are using gravity to assist you by elevating your leg above your heart level so we can push that fluid back towards your heart.
• 28:33
  SPEAKER_00: And gravity is your friend here.
• 28:35
  SPEAKER_00: It could also not be your friend if you're too vertical, which is why if you're on your feet and standing for a long time, guess where fluid wants to go?
• 28:43
  SPEAKER_00: Towards your legs and towards your knee, because that is the place where it is finding it's needed.
• 28:48
  SPEAKER_00: And so then, therefore, that's why we're saying get off your feet, elevate your leg, and get it above your heart because it's gonna help to push that fluid back towards your heart and away from the knee.
• 29:00
  SPEAKER_00: And so we always say elevate the leg early and often get it high above you as you can, um, not too high to where you're just constantly hanging out on a wall and you're vertical like a 90-degree angle.
• 29:12
  SPEAKER_00: There are times and places for that which we like and it should be totally fine.
• 29:16
  SPEAKER_00: Um, but getting that thing elevated and using just pressure to be able to allow that to come down just by nature of gravity.
• 29:25
  SPEAKER_00: Um, and so that's something that we love to do is elevate the leg.
• 29:29
  SPEAKER_00: It promotes venous return and lymphatic drainage because of the elevation and that gravity assisting.
• 29:36
  SPEAKER_00: This allows it to reduce that pooling of that excess fluid in the knee joint.
• 29:41
  SPEAKER_00: There was a study by D Giovanni in 2013 that showed this with elevation and the venous return and lymphatic drainage.
• 29:49
  SPEAKER_00: And it's just something by nature of the way our human bodies work and the biology of it, right, and our physiology, like that's the way that it is going to help to be able to get fluid out.
• 30:01
  SPEAKER_00: And that's where lymphatic drainage comes in.
• 30:04
  SPEAKER_00: Lymphatic drainage, so we have a lymph lymph node system, right?
• 30:07
  SPEAKER_00: Or a lymphatic system, and we have lymphatic vessels and lymph nodes.
• 30:12
  SPEAKER_00: They absorb excess uh fluid that is within our joints and areas, including like inflammatory fluid, right?
• 30:21
  SPEAKER_00: Um, from the swollen knee, for example, and they move it towards like different regions of different lymph nodes.
• 30:28
  SPEAKER_00: So, for example, you have a popliteal lymph node that is behind your knee, um, and then that will help to be able to push fluid up towards your inguinal lymph nodes, which is in the groin region.
• 30:41
  SPEAKER_00: So it's basically this highway system, just like your bloodstream, that is a lymphatic system as well.
• 30:47
  SPEAKER_00: And that's gonna help to move fluid along in our bodies.
• 30:52
  SPEAKER_00: Um, and once it's filtered, the fluid will actually re-enter the circulation through the thoracic duct and then gets back to the bloodstream.
• 31:02
  SPEAKER_00: And so, for you guys to just like understand this kind of like circle of what happens with fluid, is that there is this whole system in our body built to help circulate the fluid and it comes out through our thoracic duct and then gets back to our bloodstream.
• 31:17
  SPEAKER_00: So that is something that is super important, but different from our circulatory system, where the heart is pumping blood through the body, right?
• 31:27
  SPEAKER_00: Um, the lymphatic system relies actually on movement and muscle contractions to transport fluid.
• 31:33
  SPEAKER_00: That is huge for us in this process because we want to make sure we can use that to our advantage to move fluid swelling, effusion out of the joint.
• 31:43
  SPEAKER_00: So, yeah, propping the knee up on some pillows or up on a wall for a period of time is going to be helpful.
• 31:51
  SPEAKER_00: We will tell our athletes, hey, yeah, do this when you can, especially post-op, post-injury.
• 31:56
  SPEAKER_00: Um, even if you're later in the process, just get that leg up above the heart and hang out there.
• 32:02
  SPEAKER_00: Hang out there for 15 minutes, 30 minutes, 45 minutes, do it multiple times a day and just see how the knee responds.
• 32:08
  SPEAKER_00: And typically that helps a lot with getting some of that fluid out.
• 32:12
  SPEAKER_00: And so these are the main points I wanted to cover for today's episode, for part one in this series.
• 32:19
  SPEAKER_00: So stay tuned for part two coming up because I've made this episode long enough as it is.
• 32:25
  SPEAKER_00: You're like, how did you only touch on three points?
• 32:28
  SPEAKER_00: There were points within that, right?
• 32:29
  SPEAKER_00: And we had to kind of lay the groundwork here.
• 32:32
  SPEAKER_00: And so this is part one.
• 32:34
  SPEAKER_00: Catch next week where we will dive into part two talking about more of these different ways to improve swelling, strategies, important principles around this.
• 32:45
  SPEAKER_00: And at the end of part two, I will also make it a bit more practical for you guys, and that way you know what to take away from these episodes.
• 32:54
  SPEAKER_00: But it's important to give you context, understand the why behind this.
• 32:58
  SPEAKER_00: That way you're more educated with this, and then therefore, if you ever experience something in the future, you're like, okay, cool, I know what to do, and I have strategies around to do that and pick and choose what makes the most sense for you.
• 33:09
  SPEAKER_00: So stick around for this series.
• 33:11
  SPEAKER_00: It's one that is long overdue, to be honest, and I'm excited to dive into part two.
• 33:17
  SPEAKER_00: Until next time, team, this is your host, Robbie Patel, signing off.